Name of the Procedure:

Complete Repair of Tetralogy of Fallot without Pulmonary Atresia

Summary

This procedure is an open-heart surgery performed to correct Tetralogy of Fallot, a congenital heart defect. The surgery involves addressing four heart abnormalities to improve blood flow and heart function, excluding pulmonary atresia.

Purpose

The procedure corrects the heart defect known as Tetralogy of Fallot, which includes four related heart abnormalities: a ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. The goal is to improve oxygen-rich blood flow to the body and ensure better overall cardiac function.

Indications

• Cyanosis (bluish skin due to low oxygen levels)
• Difficulty breathing
• Failure to thrive or poor growth in infants
• Dizziness or fainting spells
• Diagnosed Tetralogy of Fallot through imaging tests

Preparation

• Fasting for 6-12 hours prior to surgery
• Adjusting or pausing certain medications as directed by the doctor
• Preoperative tests such as echocardiogram, electrocardiogram (EKG), and blood tests

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the heart.
3. The heart-lung bypass machine is used to take over the heart's pumping action.
4. The ventricular septal defect (hole in the heart) is closed with a patch.
5. The narrowed pulmonary valve is widened, and any obstructed pathways are relieved.
6. The thickened muscle of the right ventricle is reduced.
7. The overriding aorta is repositioned if necessary.
8. The heart is restarted, and the incision is closed.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

The surgery is performed in a hospital operating room specialized in cardiovascular procedures.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (to manage the heart-lung bypass machine)
• Pediatric cardiologist (if pediatric patient)

Risks and Complications

• Infection
• Bleeding
• Arrhythmias
• Stroke
• Residual heart defects requiring further treatment

Benefits

• Improved oxygen levels and circulation
• Relief from symptoms like cyanosis and breathlessness
• Better growth and development in children
• Enhanced quality of life and reduced risk of future heart complications

Recovery

• Initial recovery in the intensive care unit (ICU) for close monitoring
• Hospital stay of approximately one to two weeks
• Restricted physical activity for several weeks
• Regular follow-up appointments with a cardiologist
• Lifelong cardiac monitoring and possible medications

Alternatives

• Palliative procedures (e.g., shunt placement) for temporary symptom relief
• Heart transplant in cases of severe cardiac dysfunction (rare)
• Non-surgical management with medications (limited effectiveness)

Patient Experience

• The patient will be under general anesthesia and not feel pain during the surgery.
• Post-operative discomfort is managed with pain medications.
• Gradual improvement in symptoms over weeks to months.
• Some initial fatigue and restricted activities as the heart heals.